According to a recent article by Modern Healthcare the CMS has announced that four additional states have opened for up for registration for Medicaid incentive payments. This brings the total number of states involved in the program to 27.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

The four states that have most recently launched their Medicaid meaningful use programs are Florida, Georgia, Illinois and Oregon.

Eligible Providers began signing up beginning Sept. 5 in Florida and Illinois., September 9th in Georgia and they can begin signing up beginning September 28th in Oregon.

Medicaid EHR Incentive Programs have recently been launched in Rhode Island, Connecticut, Arizona and West Virginia bringing the total number of states to have launched programs to 21. Eligible professionals and hospitals in those 21 states will be able to complete their incentive program registration at the state level and can receive incentive payments.

The list of states with active Medicaid EHR Incentive Programs are:

Alaska

Iowa

Kentucky

Louisiana

Michigan

Mississippi

North Carolina

Oklahoma

South Carolina

Tennessee

Texas

Alabama

Missouri

Indiana

Ohio

Pennsylvania

Washington

Rhode Island

Connecticut

Arizona

West Virginia

You can stay up to date with the complete list of states at the CMS Website here.

Earlier this week the Centers for Medicare and Medicaid Services has released five more frequently asked questions (FAQs) about the meaningful use incentive program. The questions and answers are below:

Question 1: For the meaningful use objective of “capability to exchange key clinical information” for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, does exchange of electronic information using physical media, such as USB, CD-ROM, or other formats, meet the measure of this objective?

Answer 1: No, the use of physical media such as a CD-ROM, a USB or hard drive, or other formats to exchange key clinical information would not utilize the certification capability of certified EHR technology to electronically transmit the information, and therefore would not meet the measure of this objective.

For the purposes of the “capability to exchange key clinical information” measure, exchange is defined as electronic transmission and acceptance of key clinical information using the capabilities and standards of certified EHR technology (as specified at 45 CFR 170.304(i) for EPs and 45 CFR 170.306(f) for eligible hospitals and CAHs). We expect that this information would be exchanged in structured electronic format when available (e.g., drug or clinical lab data); however, where the information is available only in unstructured electronic formats (e.g., free text or scanned images), the exchange of unstructured information would satisfy this measure. For more information about electronic exchange of key clinical information, please refer to the following FAQ: http://questions.cms.hhs.gov/app/answers/detail/a_id/10270/kw/10270.

Please note that this objective is distinct from objectives such as “provide a summary of care record for each transition of care,” where electronic exchange of the summary of care record is not a requirement but an option. To satisfy the measure of the “provide a summary of care record for each transition of care” objective, a provider is permitted to send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver. In this case, the use of physical media such as a CD-ROM, a USB or hard drive, or other formats could satisfy the measure of this objective.

Question 2: For the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, how should an eligible professional (EP) who orders medications infrequently calculate the measure for the “computerized provider order entry (CPOE)” objective if the EP sees patients whose medications are maintained in the medication list by the EP but were not ordered or prescribed by the EP?

Answer 2: The CPOE measure is structured to minimize reporting burden. However, if all of the following conditions are met it can also create a unique situation that could prevent an EP from successfully demonstrating meaningful use. An EP who:

1. Prescribes more than 100 medications during the EHR reporting period;

2. Maintains medication lists that include medications that they did not order; and

3. Orders medications for less than 30 percent of patients with a medication in their medication list during the EHR reporting period.

In these circumstances, an EP may be both unable to meet this measure and unable to qualify for the exclusion. In the unique situation where all three criteria listed above apply, an EP may limit their denominator to only those patients for whom the EP has previously ordered medication, if they so choose. EPs who do not meet the three criteria listed above must still base their calculation on the number of unique patients with at least one medication in their medication list seen by the EP during the EHR reporting period regardless of who ordered the medication or medications in the patient’s medication list.

Question 3: How should patients in swing beds be counted in the denominators of meaningful use measures for eligible hospitals and critical access hospitals (CAHs) for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer 3: A number of the meaningful use measures for eligible hospitals and CAHs require the denominator to be based on the number of unique patients admitted to the inpatient or emergency department during the EHR reporting period. Unique swing bed patients who receive inpatient care should be included in the denominators of meaningful use measures. However, if the eligible hospital or CAH’s certified EHR technology cannot readily identify and include unique swing bed patients who have received inpatient care, those patients may be excluded from the calculations for the denominators of meaningful use measures.

Question 4: How should nursery day patients be counted in the denominators of meaningful use measures for eligible hospitals and critical access hospitals (CAHs) for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer 4: Nursery days are excluded from the calculation of hospital incentives because they are not considered inpatient-bed-days based on the level of care provided during a normal nursery stay. In addition, nursery day patients should not be included in the denominators of meaningful use measures. However, if the eligible hospital or critical access hospital’s (CAH’s) certified EHR technology cannot readily identify and exclude nursery day patients, those patients may be included in the calculations for the denominators of meaningful use measures.

Question 5: What lab tests should be included in the denominator of the measure for the “incorporate clinical lab-test results” objective under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs?

Answer 5: For the “incorporate clinical lab-test results” objective, the denominator consists of the number of lab tests ordered during the EHR reporting period by the eligible professional (or authorized providers of the eligible hospital or critical access hospital (CAH) for patients admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 and 23)) whose results are expressed in a positive or negative affirmation or as a number. Providers may limit the denominator to only those lab tests that were ordered during the EHR reporting period and for which results were received during the same EHR reporting period.

This week Indiana was one of the first 15 states to open their Medicaid EHR Incentive Programs for registration to Medicaid eligible professionals (EPs) and eligible hospitals. EPs and eligible hospitals will be able to receive Medicaid EHR incentive payments after successfully registering and having adopted, implemented, or upgraded certified EHR technology. Eligible professionals can receive up to $63,750 over six years, and eligible hospital payments begin with a $2 million base payment.

“We are extremely pleased to receive federal approval for the launch of Indiana’s EHR Incentive Program,” said Pat Casanova, Director of Indiana’s Office of Medicaid Policy and Planning. “This enhances our ability to assure continued improvements in healthcare quality, efficiency and safety for all Hoosiers.”

By using certified EHR technology, providers and patients can be confident that the electronic health information technology products and systems they use are secure, maintain confidentiality, and can work with other systems to share information.

Just in case you’ve been swamped with other things this is a reminder post that the attestation period for the Medicare Electronic Health Record (EHR) Incentive Program begins next Monday, April 18, 2011. If you expect to receive your Medicare EHR incentive payment, you must attest through CMS’ web-based Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.

Here is more information to help you prepare for Medicare attestation:
You need to understand the required meaningful use criteria to successfully attest. Meaningful use requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare EHR Incentive Program are different:

You should also make sure that you begin your 90-day reporting period in time to attest and receive a Medicare payment in 2011. The last day to begin your 90-day reporting period for 2011 incentive payments is:

July 3, 2011, for eligible hospitals and CAHs, and

October 1, 2011, for EPs.

Under the Medicaid EHR Incentive Programs, the date when participants can begin attestation for adopting, implementing, upgrading, or demonstrating meaningful use of certified EHR technology varies by state. Go to the Medicaid State EHR Incentive Program web tool for more information about your state’s participation in the Medicaid EHR Incentive Program.

According to the The Centers for Medicare and Medicaid Service the attestation for the Medicare Electronic Health Record (EHR) Incentive Program begins on April 18, 2011. In order to receive your Medicare EHR incentive payment, you must attest through CMS’ web-based Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.

To get an early start on what’s expected you can preview a PDF version of selected screenshots of the Attestation System to help you understand what the process will involve. According to CMS these screenshots are only examples—the final appearance and language may change.

CMS will release more information about the Medicare attestation shortly, including User Guides that will provide step-by-step instructions for completing attestation, and educational webinars that describe the attestation process in-depth. [Read more…]

Health Data Management is reporting that the Medicaid programs in Oklahoma and Kentucky have issued their first EHR meaningful use incentive checks. The checks were issued on January 5th, only two days after registration for the Medicare and Medicaid programs started.

According to the article the University of Kentucky Healthcare received the first hospital payment, $2.86 million while in Oklahoma, two physicians at Gastorf Family Clinic in Durant received first-year checks of $21,250 each.

On January 3, registration began in the Medicaid EHR Incentive Program in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. In February, registration will open in California, Missouri, and North Dakota. Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

Funding for the incentive payments programs was made available through the Health Information Technology for Economic and Clinical Health Act provisions of the American Recovery and Reinvestment Act of 2009. Registration for the program opened Jan. 3.

The HIMSS Electronic Health Record Association (EHR Association) has submitted its detailed responses on two major regulations that implement healthcare IT incentive provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). One comment addressed the Office of the National Coordinator for Health IT (ONC) Interim Final Rule (IFR) on EHR certification criteria and standards. The other commented on the Center for Medicare and Medicaid (CMS) Notice of Proposed Rule-Making (NPRM) on meaningful use criteria and associated payment policies.

“This collaboration engaged more of our member companies than anything we’ve done in our five year history,” said Justin Barnes of Greenway Medical Technologies and Association Chairman. “The breadth of experience and differing perspectives, including input from our customers, that went into developing our positions make our comments and recommendations a very strong complement to input from individual companies,” Barnes went on to say. [Read more…]

The following is a statement by Spencer Berthelsen, MD of the Kelsey-Seybold Clinic:

The national health care debate is far from over. Days removed from his televised national health care forum, President Obama is calling for an “up or down” vote on the measure within the next few weeks.

In his recent State of the Union address, President Obama asked if anyone had a better approach to holding the line of health care spending. I do. Stay true to the original goals of reform.

Adopt Medicare and Medicaid payment policies that reward quality, efficiency, and care coordination across many medical specialties. Incentivize the use of health information technology, especially Electronic Medical Records systems which promote information sharing. Minimize the need for doctors to practice defensive medicine. And lastly, do not harm proven state liability reforms, such as those enacted in Texas, that have delivered thousands of new doctors and a record increase in charity care. [Read more…]

The prospect of the U.S. healthcare system moving from paper to electronic medical records (EMR) has given rise to a host of thorny questions on matters of privacy, security, logistics and more. But according to EMR attorneys at the national law firm of LeClairRyan, the time to start making the switch is now-in part because the federal government will soon finalize important new guidelines on what healthcare providers need to do in order to “go digital.”

Already, some $35 billion in EMR incentives are available through the federal Centers for Medicare & Medicaid Services (CMS). However, healthcare providers-who are required by law to make “meaningful use” of EMR in order to receive $44,000 EMR-implementation grants-have been waiting for the government to clarify the meaning of this term before investing in new systems, noted senior counsel Patrick J. Hurd, a veteran medical industry attorney based in LeClairRyan’s Norfolk, Va., office. [Read more…]